1985, 12-12 Permit App 00009117 GarageDEPARTMENTAL REVIEW
Approved
Cond.
Approval
Hold
/ Environmental Health Application #
W. 1101 College
Room 200
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Ijars
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(14
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
I
Plan Review/Fire Prevention
N. 811 Jefferson
Other (SEPA/Crlitical Material/etc.)
Fast Track/Special Inspection Information
Project Representative
1
Phone
Address
certify that I have examined this application and state that the information contained in it and submitted
by me or my agent to compile said application is true and correct.
Signature I eiLl
Date
/a//p-
(THIS IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
COMPLETE IN INK
(Please return this original and your building plans to the Department of Building and Safety)
J r14.% L/C Li /1n CAA 'Arm run uCrmr{ 1 IVI CIN I HL VJC '
Project Number
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Owner's Name LAST FIRST MI
F.5 /0. e,i52RR y
Project Address (Street Name & Number) i. Zip
9/? 5 Cc? is/ ill S
Applicant �J
z__ s ;line 6 ��4. It 5
Address
4 3 e{ G A741 c.� Ail
City /�
r Rae,/ 01U E
State
liJif
Zip
Phone
( )
Business Phone 0
Contractor/Agent
Address
City
State
Zip
Phone
( )
Contact
I _,
License Number (Required)
Business Phone
( )
Architect/Engineer ,.�
�b.T35 HS 5 - r
Address
City
State
Zip
Phone
( )
Contact
Business Phone
( )
Lender
Address
City
State
I Zip
Phone
Describe Work
fin) 4 a i /d, 1. t ? C94°,75,&--- aY X 0/, I
Res.
✓
Comm.
Subdivision/Plat Name/Short Plat Number
Sou hF COL C,i NS kVO
Assessor Parcel Number
2_4;-167c3
Lot
3
Block
`Z-
Plat Number
Pertinent File Numbers
Zone_.F�
Comp. Plan
Census Tract
Number of Dwelling Units
G
Number of Buildings
C-
Lot Size (Sq. Ft./Acre)
Depth
IBC,
Frontage
(co'
Front Setback
Left Setback t
Right Setback
Rear Setback i
R/W Width
Additional Information
I BUILDING INFORMATION
Square Footage
Number of Bedrooms
Building Technician
_IN m -
Date
IZ - I L-0\
Group
-1
Type
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Show on Site Plan:
Additional Information:
Lot Dimensions
Existing
Landscaping
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Structures
Proposed Improvements
Drainage Plan
Hydrants
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Structure Setbacks
Topography
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■EasementsLightingIISeptic
System (s)Signage
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Water Lines
Sewer Lines
ShorelinesIIIMI
Highwater Mark
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Wells
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ghtofWayWidth(s)
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Fronting Street
Street
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Legal Description
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Revisions: Attachments:
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